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Talking with Dr. Ted Schettler is probably unlike any conversation you have had with your physician. Raise the topic of breast cancer or diabetes or dementia, and Schettler starts talking about income disparities, industrial farming, and campaign finance reform.

The Harvard-educated physician, frustrated by the limitations of science in combating disease, believes that finding answers to the most persistent medical challenges of our time鈥攃onditions that now threaten to overwhelm our health care system鈥攄epends on understanding the human body as a system nested within a series of other, larger systems: one鈥檚 family and community, environment, culture, and socioeconomic class, all of which affect each other.

It is a complex, even daunting view鈥攚here does one begin when trying to solve problems this way?

Schettler is an exceedingly logical thinker, and his vision for a more evolved kind of health care came from the down-to-earth experience of helping to clean clam flats along the St. George River in Maine during the 1980s. 鈥淚 was living and practicing on the coast there, and working with a local organization to clean up the river because we had these rich clam flats that had been closed for years because of periodic spikes of E. coli. If anyone ate the clams they would get very sick.鈥�

Meanwhile, paper mills were dumping dioxins into other rivers nearby, and Schettler learned that fish from those rivers sometimes had even higher chemical levels than fish caught in urban harbors. But factory bosses claimed that regulating waste from the pulp mills would cost community jobs, which prompted dozens of young factory workers to protest. Schettler, despite being steeped in traditional medicine, was unable to ignore these interrelationships: a degraded natural environment, a precarious local economy, and perennially sick people. 鈥淭hese things鈥攖he effect of the environment on peoples鈥� health鈥攚ere never discussed at the medical conferences,鈥� he said. 鈥淪o it caused in me a major re-examination.鈥�

Schettler went back to school, earned a master鈥檚 degree in public health, and began applying a scientist鈥檚 rigor to his wide-ranging pool of interests. Since then, he has researched connections between poverty, iron deficiency, and lead poisoning; insecticide use, Parkinson鈥檚, and Alzheimer鈥檚 disease; income disparities and asthma.

He calls this new approach to medicine 鈥渢he ecological paradigm of health.鈥�

鈥淚t sounds like tree-huggers or something,鈥� Schettler said in an interview. 鈥淏ut I mean 鈥榚cological鈥� in the sense that there are these multiple systems, one within the other鈥攁 family within a community, within a society, within a culture鈥攁nd that鈥檚 the way ecologists tend to talk about ecosystems. It鈥檚 accepting up front that humans do not stand apart from the environment. We鈥檙e a major species, along with the mosquitoes and fish and trees and bacteria. And there are all of these wonderful interrelationships.鈥�

Our Health and Ecosystem Health

Currently getting over a case of Lyme disease, Schettler notes that the condition wasn鈥檛 even on the radar three decades ago. Likewise, West Nile Virus. And dengue fever, first identified in the late 18th century, has soared since the 1960s, now infecting up to 100 million people worldwide each year.

鈥淐an there be any doubt that human health is enormously dependent on ecological systems that we are having a major influence on?鈥� Schettler says. 鈥淚t鈥檚 all one world. Our tendency to describe the natural world as something without humans is part of the problem.鈥�

Such a holistic approach to human health is often received as heresy within traditional medicine, but Schettler is hardly a Don Quixote tilting at windmills. He has testified before the U.S. Senate about links between Parkinson鈥檚 and pesticide use. He has been interviewed on public radio and co-authored two oft-quoted books, Generations at Risk: Reproductive Health and the Environment and In Harm鈥檚 Way: Toxic Threats to Child Development. Both explore Schettler鈥檚 belief about the environmental underpinnings of a host of disorders, from learning disabilities to cancer. And both lay out the limitations of Western medicine in coming up with clear causes and effective treatment.

When economic inequality gets this wide it has an adverse effect on people鈥檚 health.

Breast cancer is a prime example. Dissatisfied with research into the origins of the disease, Schettler began to wonder whether chemicals found in cancerous breast tissue actually encouraged tumor growth. He found that a girl鈥檚 exposure to DDT before the age of 14 corresponded to a greatly increased risk for breast cancer later in life. 鈥淚f we鈥檙e looking only at adults, we鈥檙e missing this important window of susceptibility,鈥� Schettler says. 鈥淏ut in medicine we weren鈥檛 going there. We were responding only to the illness. I was interested in its origins.鈥�

Food is another favorite 鈥渨edge issue,鈥� a way of examining diseases like diabetes in relation to agricultural policies. Schettler, noting America鈥檚 current epidemic of childhood obesity and diabetes, began examining not only blood sugar levels in children but also the neighborhoods in which they lived. He found that many did not have a single market selling fruits and vegetables.

That led his musings a step further, to inquiry into the agricultural policies guiding food into stores. Which flowed naturally into an examination of conditions for agricultural workers who, it turned out, had high rates of cancer.

In Schettler鈥檚 analysis, each of these factors鈥攖he mass production of processed food, the lack of easily accessible fruits and vegetables, the health condition of farm workers鈥攊s fused with the others: 鈥淚t鈥檚 fine to give people dietary advice, and advise them to exercise鈥攊n this country we have a long history of telling people how to change their own lives,鈥� he says. 鈥淏ut it鈥檚 not just a matter of an individual making a poor choice. It鈥檚 what our system has provided to them, so it needs to be changed at the systems level. Diabetes and obesity are big-ticket items with huge implications for the federal budget.鈥�

Thinking that way, it鈥檚 no stretch for the physician to segue into a discussion of federal farm subsidies for chemically produced foods. Or, on a more personal level, to question colleagues in health care about their failure to advocate for changes to the food served in schools.

Schettler鈥檚 approach touches everyone: He asks school districts that cut physical education programs as soon as budgets get tight, 鈥淲hat鈥檚 the message we鈥檙e giving to kids? This is really troubling. We鈥檙e facing an obesity and diabetes epidemic that鈥檚 going to overwhelm our health care system. And if there鈥檚 one thing that we should be doing it鈥檚 stressing the importance of diet and exercise for young people.鈥�

You might think that a physician like Schettler鈥攗nafraid of skewering sacred cows wherever he finds them鈥攚ould be a lightning rod for criticism. And indeed, the American Council on Science and Health issued a sharp rebuke in 1999 after Schettler attacked a report issued by the organization (and co-authored by former Surgeon General C. Everett Koop) for its stand on phthalates: 鈥淭he American Council on Science and Health is disappointed, but not surprised, by activists鈥� continued attempts to discredit a panel of well-respected, nationally and internationally recognized scientific and medical professionals,鈥� the statement said. 鈥淥nce again, there has been an attempt to shift attention from sound science to misrepresentations and half-truths.鈥�

Other than this, there is virtually no public criticism of Schettler鈥檚 work. And even that fracas left him singularly unperturbed.

鈥淪ome of these chemical groups might label me an 鈥榚nviro鈥� but that鈥檚 about it,鈥� he said. 鈥淪till, this is an area of great debate鈥攚hether our job is merely to identify and treat disease or whether it is also to be advocates in public policy.鈥�

Clearly, Schettler has made his decision. 鈥淵ou really do get into down-and-dirty politics here. That鈥檚 where this all plays out.鈥�

Inequality Makes Us Sick

Wherever Schettler turns his focus, drilling down to the root causes of illness inevitably means confronting social problems, foremost among them economic inequality.

Take lead poisoning: Poor diet leaves children from lower-income families more likely to suffer iron deficiencies. And an iron-deficient diet allows more lead to be absorbed in the intestinal tract, transporting more of the damaging metal to the brain and leading to increased neurological impairment among kids whose families are least able to counter those effects.

鈥淚f you just address the lead itself, without looking at diet and social circumstances, you don鈥檛 get very far,鈥� Schettler says. 鈥淪o yes, it鈥檚 important to make sure that kids aren鈥檛 being exposed to excessive amounts of lead and neurotoxins, and we need to keep doing that work. But we also need to be looking at housing, income disparities, the food system, energy production鈥攖hings that are likely to have a bigger impact on a larger set of conditions and diseases.鈥�

In short, poverty leads to increased exposure, which is exacerbated by heightened vulnerability (in this case, the iron-deficient diet) and an impaired ability to respond鈥斺�渁 toxic triad,鈥� Schettler calls it.

The link between socioeconomic status and poor health is widely acknowledged. But perhaps less obvious is the finding that income disparities within a community also appear to have a deleterious effect, making one family susceptible to illnesses that another living in the same area鈥攂ut at a higher income level鈥攎ight escape.

As proof, Schettler cites research on asthma that found poorer kids鈥攅ven when symptom-free鈥攈ad higher levels of inflammatory markers in their blood than youths from wealthier families in the same neighborhood. Meaning that it took fewer irritants to push the poorer children over the threshold into a full-blown attack. Once sick, they were also less resilient鈥攖hat is, less able to quickly recuperate鈥攖han wealthier children, either because they lacked treatment at home or were unable to get to a doctor.

鈥淗igher income is protective鈥攅ven in the same community,鈥� Schettler says. 鈥淭hat鈥檚 why it鈥檚 so concerning to see this income gap in America now. We know it鈥檚 setting the stage for adverse health outcomes for people. Is that class warfare? Well, yes. When economic inequality gets this wide it has an adverse effect on people鈥檚 health. That鈥檚 what the literature tells us. We shouldn鈥檛 shy from saying it.鈥�

Show Me the Progress

After spending 30 years as an emergency medicine physician, Schettler now serves as science director for two organizations, the Science and Environmental Health Network and the Collaborative on Health and the Environment. The latter is a partnership of some 4,000 health practitioners and scientists committed to promoting discussion of the connections between the environment and learning disorders, birth defects, infertility, childhood leukemia, endometriosis, and various cancers.

Admittedly, it鈥檚 a pretty bleak vision, this tangled web of social, medical, and political problems. And looking at it, you might expect Schettler to be wracked with hopelessness. Yet he is not.
鈥淚 actually think it鈥檚 a very important time in the world now,鈥� he says. 鈥淭here鈥檚 something here for everyone to do.鈥�

He points to examples of significant change already underway within the health care industry itself, where the incineration of hospital waste has long been a leading source of dioxin emission. Hospital food, too鈥攖raditionally a fatty rotation of grilled cheese, burgers, French fries, and milkshakes鈥攈as been little more than 鈥渁 joke,鈥� Schettler says.

But since its founding in 1996, the international collective Health Care Without Harm has steadily been chipping away at these problems, and has now seen the closure of thousands of medical waste incinerators. It has initiated a Green Building program geared toward creating energy-efficient medical centers; and it has begun to change the way hospitals, with their enormous purchasing power, buy food to promote more locally grown and sustainable agriculture practices.

鈥淭he medical industry itself has been a great place to look at cleaning up,鈥� says Schettler, who advises Health Care Without Harm. 鈥淧articularly as health care is almost 20 percent of the GDP.鈥�

Even as a high school student in 1950s Ohio, the seemingly mild young man showed a talent for leadership. (鈥淭ed鈥檚 ability to organize his pals has made him a leader in the senior class,鈥� notes his yearbook. 鈥淗is sincere, fun-loving personality will draw friends to him.鈥�) These days, Schettler puts those skills to work before crowds of students, researchers, and policy makers. Yet nearly every conversation circles back to same question: How is anyone to make a difference when confronted with Schettler鈥檚 vision?

鈥淚 encourage people to recognize that they鈥檙e working in common cause with others,鈥� he says. 鈥淢any people are carrying a common message, just coming at it from different angles.鈥�

By way of example, he cites Detroit, long a metaphor for urban blight, ingrained misery and societal failure. Though there is not a single major-chain supermarket within the city limits, Schettler focuses instead on a crop of urban gardens now dotting the broken blacktop. 鈥淧eople are starting to grow their own food, healthy food!鈥� he exclaims. 鈥淭here are wonderful things going on.鈥�

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Claudia Rowe is a Seattle-based journalist and editor focusing on the impact of public policy on private lives. She is a two-time Pultizer Prize nominee and the author of The Spider and the Fly, for which she won the 2018 Washington State Book Award.

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